MSMS Legislative Blog

Thursday, February 13, 2014

Budget is the word on the street with both chambers a buzz about the upcoming budget season in Lansing. The official start of the season was on February 6th, when Governor Snyder presented his recommendations for that state budget for the coming fiscal year. This past week state departments started to get down to the individuals budgets for the departments and meeting with their respective appropriations subcommittees. Director Jim Haveman of the Department of Community Health delivered the budget message for to the House and Senate this week. Let's review those messages:

Governor's Budget Message:

Slide from Governor Snyder's Budget Presentation.

Both House and Senate Appropriations members gathered in the House Appropriations committee chambers to hear what message the Governor was going to bring to the legislature on the coming fiscal year. The Governor spent the start of his message reviewing the past three years that the Governor has had the reigns in Michigan. His message of Michigan being the come back state seemed to become the tag line that every member of the committee left with.

In the health arena the Governor wanted to focus new money on the following:

An investment of $71.7 million for the Healthy Michigan Plan to implement expanded Medicaid coverage.

$15.7 million in gross funding to expand the Healthy Kids Dental program into Kalamazoo and Macomb counties, providing an additional 100,000 children with good dental care.

A total of $15.6 million to support the initiatives as recommended in the Mental Health Commission final report that was issued Jan. 2.

The Governors Mental Health Commission had recently reviewed their findings from their hard work to a joint meeting of the House and Senate Health Policy committees a few weeks ago but from that meeting there was no talk of what the Governor wanted in terms of funding for program, with the presentation of the budget lawmakers found out how much some of the efforts of the commission was going to cost.

The Healthy Michigan Plan along with Healthy Kids Dental both saw bumps in funding as well, as the Governor continues his push to expand coverage for health care and dental care for children in Michigan. Moving away from health the Governor also talked about road funding and a need for an increase in funding and toted a funding increase for schools that is directed to the classroom. You can see the governor's presentation here.

Director Haveman's Presentation:

Director Haveman had the daunting task of breaking down the budget for his department, providing both the House and Senate a presentation of the accomplishments of the current fiscal year and what the road map for the coming fiscal year looked like for the department. The Governor in his state of the state address said that he wanted to make Michigan a "no wait" state for certain services. The Department of Community Health Houses some of those services, lets review the recommendations for the coming year:

Slide from Director Haveman's Presentation.

Overall Budget: $17.4 Billion Gross / $2.9 Billion General Fund (GF)

Mental Health and Wellness Commission - $15.6 Million Gross

Jail Diversion Initiatives - $3.4 Million (DCH Investment)

Child and Adolescent Health Services Pilot - $2 Million Gross/GF

Home visitation in rural areas - $2.5 Million Gross/GF

Crime Victim Grants - $1 Million Gross (From Crime Victim Fees)

Make Michigan a “no wait state” for senior home delivered meals and in home services - $5 Million Gross/GF

Increase Program of All-Inclusive Care for the Elderly (PACE) site options - $16.4 Million Gross / $5.7 Million GF

Make Michigan a “no wait state” for the MiChoice Home and Community Based Waiver Program - $26.4 Million Gross / $9 Million GF

You can see the full presentation delivered by the director here. Graduate Medical Education was a topic that briefly touched upon in the committee. It is expected that further discussion on the administrations direction with the budget will come when the Medical Services or Medicaid will report to the committee in the coming weeks.

The budget hearing will continue through February and March. Stay with MSMS to get the latest up to date news on the budget process and more as issues break at http://www.msms.org/advocacy .

Tuesday, January 21, 2014

With an overhaul and update of the blogging site, the MSMS Legislative Update is back up and running again and we are happy to provide the latest up to date happenings in Lansing and beyond. This month we find the legislature facing it's final year of the term, leaving law making playing second fiddle to the upcoming campaigns ahead of the lawmakers. This also means the timetables are accelerated which leaves the possibility of a state budget being done before the start of June. Lets review the happenings of the legislature over the past couple weeks.

Consensus Revenue Estimating Conference:

The month started out, as per usual, with the two fiscal agencies and the Michigan Department of Treasury coming together to sign an agreement on the amount of tax dollars the state will have to spend in the coming fiscal year and how the economy in Michigan is looking and will look in the future. All parties agreed that Michigan is continuing its financial recovery at a slow up strong pace. Current new starts of homes are continuing to rise in Michigan and are projected to continue on that upswing. Good news for those working and those looking for jobs with the personal wealth of people continues to rise and unemployment is projected to fall leaving people with work and more money in their pockets.

As for the state's coffers those continue to rise as well. Tax reforms done by the legislature with the cutting of the Earned Income Tax Credit, modifying the homestead tax credit, and the elimination of the child deduction, Michigan will decrease it's tax expenditures by $2.5 Billion for FY 13-14 (courtesy of the Senate Fiscal Agency). This for the coming fiscal year law makers found out that they will have an additional $474 Million to appropriate. Some are calling for a tax refund, some would like to see road work, some would like to see the tax deductions put back into place, but it will be a wait and see until the Governor releases his budget recommendation to see where the money ends up going. Click on the link to see the final estimates.

State of the State Address:

Governor Snyder delivering fourth State of the State Address.Courtesy of MLIVE.

On January 16th Governor Rick Snyder presented his report to the legislature on the report card of Michigan. The speech started out with a review the past three years of the Governor's term talking about the points that he was proud of accomplishing including the safe sleep initiative, a policy move that MSMS supports. From there Governor Snyder moved towards his agenda on what he wanted to do yet and really started laying out his campaign platform for the coming elections. Here is a great breakdown from our multi-client lobbyists at Capitol Strategies Group:

The Governor presented his annual State
of the State address Thursday evening in Lansing in front of a packed House
chambers on a snowy night in Lansing. Many of the pundits in Lansing concluded
the speech lacked many specifics, but below is excerpts from the speech
released by the Governor’s press office.

Snyder will create the Michigan Office
for New Americans, which will drive strategies for attracting immigrants to
Michigan. Snyder also is urging Congress to approve
Michigan’s application to become only the second state with a state sponsored EB-5
visa regional center. The EB-5 is a tool for attracting investment and creating
jobs for U.S. workers.

Stepping up efforts to connect job
providers and talent. The governor this year again will host economic and
education summits to foster greater collaboration between the private sector
and education community.

Expanding the Michigan Advanced
Technician Training (MAT2) program, an employer-driven
initiative that helps employers bridge the “skills gap” through a statewide system
for training and educating skilled technicians to fill high-paying jobs. Henry
Ford Community College and Oakland Community College will serve as pilot
locations for the program, which is a unique model that also includes best practices
from Germany.

Continuing the successful Community
Ventures program, a public/private/nonprofit partnership created to hire at
least 1,000 structurally unemployed residents from distressed neighborhoods,
initially in the cities of Flint, Detroit, Pontiac and Saginaw. First-year
goals have been met, resulting in jobs for over 1,400 structurally unemployed
residents.

Supporting small businesses through
creative partnerships. Under the Pure Michigan Micro Lending Initiative,
Huntington Bank has committed $5 million for a pilot program in Detroit to help
small businesses grow. Upon its successful completion, Huntington will commit
$20 million more to be distributed through lines of credit to community micro
lenders. Under another initiative, the 10,000 Small Businesses program, Goldman
Sachs announced a $20 million partnership to help entrepreneurs in Detroit by
providing access to education, financial and business support services.

21st Century Education

Ensuring that
Michigan’s education system is indeed a 21st century system that reflects the
needs of this technology age. This includes:

Encouraging schools to consider a
voluntary program in which they would extend classes year-round, rather than
interrupting student learning with a three-month summer break. It can take
weeks for many children to recover the information they learned prior to
leaving for the traditional summer vacation, which delays the learning of new
material. Under this concept, students still would get shorter breaks
throughout the summer. Snyder applauded the Legislature’s bipartisan effort to
explore this concept and urged further action.

Providing a uniform
definition of “truancy” to schools across the state. Doing so will result in
greater consistency and will provide educators, human service providers, judges
and police with ample opportunities to customize assistance to families so that
the number of truants can be reduced.

Implementing recommendations of the
Michigan Council for Educator Effectiveness. The council recommended a fair and
rigorous means to evaluate the skills of teachers using a combination of
observed classroom practice and measured student growth.

Making Michigan a leader in promoting
STEM programs in schools and colleges. Jobs are robust in the fields of
science, technology, engineering and math. Michigan must do a better job of
aligning education with economic trends and inevitability.

Quality of Life

Improving the quality of life in our
communities, as well as for seniors, and residents with special needs. The
governor said:

Michigan should
become a “no wait state” for seniors who qualify for home delivered meals and
in-home services. Nearly 4,500 seniors are not receiving the in-home services – including
home-delivered meals – that
they need. In Southeastern Michigan, half of the people qualifying for services
must wait six months or more to receive services. The governor will propose
additional funding in his recommended budget to eliminate this waiting list.
The governor also announced that he will prepare a special message outlining
opportunities to reinvent the way in which Michigan provides services to seniors.

Adopting recommendations of the Mental
Health and Wellness Report will help people with mental illness, substance
abuse disorders or developmental disabilities to lead more independent lives.
Recommendations include developing a Pure Michigan marketing strategy to
highlight opportunities for families living with disabilities, and having Michigan join the “Spread the Word to End the Word” movement, which
seeks to rid our vocabulary of derogatory terms regarding people dealing with
mental illness.

Michigan should enact laws that provide
school safety drill recommendations, and encourage schools to report on
completion of the drills to the state. Snyder will propose funding in the
upcoming budget for school safety initiatives.

The quality of life for nearly
half-a-million Michiganders will be enhanced now that the federal government
has approved the Healthy Michigan Plan. By improving access to affordable
health care coverage, Healthy Michigan also will reduce uncompensated care that
shifts costs onto businesses and taxpayers.

Significant progress is being made in
reducing the crime rates in Pontiac, Detroit, Saginaw and Flint. While the
rates remain unacceptably high, it’s clear that the
state
and local partnership under the Secure Cities Initiative is having an impact. In
the first 10 months of 2013, violent crimes declined by 30 percent in Flint; 16
percent in Saginaw; 7 percent in Detroit and 6.5 percent in Pontiac.

Protecting Our Environment and Natural
Resources

Ensuring the protection of Michigan’s natural resources while allowing for their wise use, the governor called
for:

Increasing the
state’s effort to combat invasive species, which cause environmental
damage, as well as economic harm in excess of $4 billion annually across the
Great Lakes region. The governor will recommend funding in the new fiscal year
to implement a program aimed at preventing the introduction and spread of both
aquatic and terrestrial invasive species. The program was developed through a
partnership with the DNR, Department of Environmental Quality and Department of
Agriculture and Rural Development.

Using the information gathered last year
through numerous public forums to develop a framework for the comprehensive
energy policy that Michigan needs. In December 2013, Snyder used that
information to set the stage for critical discussions on Michigan’s energy needs as they relate to adaptability, affordability
and reliability.

Good Government

Continuing with the reinvention of state
government so that it is customer-focused and delivers the best possible
service. The governor proposed that:

Michigan should join other states in
passing a resolution that supports a Federal Balanced Budget Amendment to the
U.S. Constitution. Unlike Michigan, Washington still lacks the fiscal
discipline to balance its budget, which hampers the nation’s economic turnaround. Passing this amendment sends a strong signal
to Washington that fiscal responsibility is needed for the good of working families
and all taxpayers, as well as future generations of Americans.

The state enhance
its “early warning system” to assist communities and schools facing financial
instability. Creating strong financial intervention teams, housed within the
departments of Treasury and Education, will allow for earlier intervention
strategies. This is in the best interests of children and taxpayers.

While continuing to be fiscally
responsible in the short and long term, it is appropriate to provide some tax
relief to hard-working families. Michigan has come a long way in three years. The state’s fiscal health has improved due to the tough but
necessary decisions that have been made. The governor will make an FY 15 budget
recommendation that eases the burden on low- and middle-income families so that
they can continue to share in Michigan’s comeback.

The state now looks ahead with the Governor's budget message on the horizon to start working to get the budget done before their self imposed deadline of June 1.

MSMS will continue to follow the activities of the budget and other areas. Find all of that information at http://www.msms.org/advocacy. Your support helps us get the policies you want passed by the legislature. Go to http://www.mdpac.org to see how you can help!

Wednesday, September 4, 2013

With the leaves starting to turn, children starting to collect their supplies for the upcoming school year and the sounds of football filling the weekends, it must mean that fall is around the corner. With that also means that the legislature is back in session ready to deal with the pending question that everyone has been working on and waiting for an answer to, Medicaid Expansion HB 4714. The Senate met this past week on Tuesday to finally answer that question, but lets review how we ended up here.

June:

The House has passed their version of the Medicaid Expansion leaving it to the Senate to work on the issue before the legislative summer break. The Senate discharges the bill from committee consideration the last week of session starting the debates internally in the Senate Republican caucus on how they were for or against the expansion. During this time the Governor is away on an economic mission in Israel and the Lieutenant Governor was in the Upper Peninsula of Michigan leaving the executives out of Lansing and leaving Medicaid floundering.

Wednesday of the final week the Lieutenant Governor cuts his trip short to head back to Lansing to work with the Senators to somehow help push Medicaid over the finish line in the Senate. At the same time two other Senators say they are working on or have alternative proposals for the Senate to consider. After Wednesday no progress had been made in moving the vote forward leaving Thursday the final day before the legislature headed out for summer and leaving the Governor on a plane back from Israel to Michigan to try to push the expansion over the finish line.

The Governor made his appearance just before noon on Thursday and starting meeting with individual senators one on one, trying to get their issues solved so that the Senate could vote on Medicaid that day. Hours dragged on leaving by 5:00 pm that day still votes short in the Senate and a frustrated Governor having a press conference saying that the Senate should stay rather than go home and solve the expansion issue. The Senate had another plan and sent the Medicaid expansion bill to the Senate Government Operations committee where a work group would be created to work on the bill over the summer. The Senate broke for the summer leaving Medicaid still hanging in the wings.

July and August:

Senator Richardville convened the Government Operations committee announcing that there would be a work group that would be drafting legislation that would be suitable to all parties in the Senate and that they would meet on a weekly basis. Senator Kahn, MD was the lead of the work group, using his experience as a physician to provide clarity, insight, and leadership to the work group. The Government Operations committee would meet every two weeks looking for an update on the progress of the work group and report to those who attended the committee meetings.

The workgroup finally came to the committee with a product at the end of July where then the committee took testimony from the interested groups on their opinions and either support or nonsupport for the legislation. The committee also considered two other Medicaid plans that were provided by Senators Collbeck and Caswell. SB 422 and SB 459 and SB 460 were the alternative plans provided to the committee. Many of the groups testifying supported HB 4714 but did not provide their support for the other pieces of legislation. At the end of the committee meeting all three plans made it out where a showdown was expected on the Senate floor.

August 27th:

The Senate came in for their final summer session day with high stakes looming over the Senate. This was the day that the Medicaid vote was going to happen, leaving the hallway to the Senate chambers full of advocates for or against Medicaid expansion ready to push votes the way they wanted to. The Lieutenant Governor was ready to break any tie votes that had come on the floor; the stage was set. The Senate took up HB 4714 where the vote on it the firs time left them one vote short 19-18 with Senator Collbeck abstaining from voting. Since this wasn't a majority of the Senate voting for the bill failed.

A reconsideration motion was made quickly after and the leadership of the Senate along with the Governor's office continued to work on the members that were still in opposition of the legislation. Finally after some amendments the vote was taken again and this time Senator Casperson, a Republican from Escanaba, switched his vote and voted for the expansion allowing the legislation to pass 20-18. The legislation still waits in the Senate thought since the chamber fell two votes short on granting the legislation immediate effect. The Senate will be considering this on Tuesday September 2nd when they come back to start their fall schedule.

Friday, June 21, 2013

The Legislature saw the light at the end of the tunnel with this being the
final week before they leave on their summer recess. This week started with the
Lieutenant Governor in the Upper Peninsula and the Governor in Israel working
on creating economic development for Michigan but with the Medicaid expansions
hanging in the balance, we saw trips being cut short with both the Lieutenant
Governor and the Governor coming back to Lansing to try to get the Medicaid
expansion across the finish line. Let’s review the week:

House:

The House started out this week with having a number of topics on the agenda
including House bill 4736 that would allow Expedited Partner Therapy in
Michigan. This was on the agenda for Wednesday for the House to take up but
everything took a back seat to what was happening across the hall in the
Senate.

Senate:

The Senate found itself in the limelight, where it wanted it or not, this
week with the possible consideration of HB 4714 or the bill that addresses Medicaid
expansion. Starting out the week the Senate Republicans were having troubles
meeting their own imposed requirement where a majority of their caucus has to
vote in favor of the legislation before they will consider an issue on the full
Senate floor. Wednesday found the majority of those lobbying in the Capitol
working on the Senate asking Senators to support the expansion. The Lieutenant
Governor made his want back to Lansing to join those lobbying the Senate
Republicans on supporting the exchange. At the end of the day, Wednesday saw no
action on the expansion and left some wondering if it would ever get done.

Thursday and final day of session before the summer break, found those
hoping for the Medicaid expansion to make its way to the Governor's desk, but
with the Governor gone in Israel for the past week, it was hard for supports of
the legislation to find any hope of moving the issue forward. Then word came
that the Governor was on his way back to Lansing and would be at the Capitol
before noon. With the Governor's arrival eminent, supports continued working
with Senators to push them to support House Bill 4714. When the Governor
arrived, he talked with his staff that had been working on the Senate, giving
him a status report, and then started working members of the Senate. This went
on for most of the afternoon where he also called representatives from the
supporting groups to fill them in on his progress which was not promising at
the time.

Finally, after five hours of working the Senate, the Governor called a press
conference with supports of the expansion asking the Senate to take a vote on
the expansion rather than heading home for summer break. Kenneth Elmassian, DO,
President of the Michigan State Medical Society was there for MSMS. "Every
discussion about health care and health policy in Lansing should start and end
with what is best for Michigan patients. The Healthy Michigan Plan puts
patients first, helping more families receive the health care they so
desperately need while being responsible with residents' tax dollars,"
said Elmassian in a statement. He went on to say, "Physicians across
Michigan are grateful for Governor Snyder's steadfast leadership and look forward
to working with lawmakers this summer and into the fall on reforms that put
patients first."

Now the Senate will be back in August on the 27th to hopefully finish the
work done on the Medicaid expansion, those supporting the package now have
until August to continue working to garner support for the package. The blog
will now take a break until the legislature comes back into session in August.
Follow MSMS though through our twitter feed and Facebook page to get up to date
information on what is happening over the summer at http://www.msms.org/advocacy.

Monday, June 17, 2013

With the clock ticking away on the amount of time left in the legislative calendar for this first part of the year, Medicaid reform was front and center throughout the entire week, leaving one chamber looking on to see what would be done. Let's review the past week.

House:

With the Senate looking on the House Michigan Competiveness Committee was signaling that there was a substitute bill to House Bill 4714 at the start of their meeting on Tuesday, where the committee continued to take testimony, this time from those individuals who are associated with the Tea Party. Comments offered to the committee from those testifying had nothing to do with the legislation but rather how they disliked the Affordable Care Act and any expansion of any government service or program. After the testimony from the Tea Party the committee adjourned and reconviened on Wednesday where they approved the legislation as substituted along with some amendments that were also tacked on by members of the committee. A further analysis of the legislation can be see here.

Dr. Kenneth Elmassian, President
of MSMS sharing his feelings
about the Michigan Medicaid Reform.

Wednesday the House moved the legislation through second reading leaving a showdown within the Republican caucus on Thursday to move the legislation out of the House to the Senate. The day started at it's usual time with both caucuses heading back to their respective rooms to discuss the upcoming vote on the Medicaid reform package. The subsititute stripped out some of the harsh language including the 48 month drop out of the program was changed to after 48 momths increasing co-pays for the program. Also an amendment was added that at the end of the 48 months a 90 day period would be added on to allow patients to be ready for the changes. After hours of working the room, those support the legislation were able to get the votes needed to pass the bill to the Senate with a vote of 76 for and 31 against.

Now the legislation heads to the Senate as they choose what to do with it over the summer break. The House did also send legislation to the Senate that would allow those who have military expereince to use that if they are looking to be licensed as an EMT. This was part of a larger package aimed to help veterans coming home looking for a job.

With a week left there are several issues still on the docket that both chambers are looking to complete before the summer break. Stay with MSMS to get the up to date information on the issues that will effect the physician community. Go to http://www.msms.org/advocacy to get all the information.

Friday, June 7, 2013

With the summer recess looming on the horizon, both chambers are looking to finish up some of the larger issues that have been on the plate for the legislature. Lets review the activity of this week and whats still to come:

Senate:

The Senate concurred with the conference report for the General Government Omnibus budget, which covers the Department of Community Health budget as well. With the budget now agreed to by the both House and Senate, it will be heading to the Governor's desk for his signature.

House:

The House Michigan Competitiveness Committee convened again this week to consider the House Republican Medicaid Reform package. House Bill 4714 would require the state to ask for a waiver for their Medicaid program that would require full support of expansion by the Federal Government along with a 48 month limit for those able bodied individuals using Medicaid. There were rumors that the legislation was going to be voted out this week by the committee but it did not happen. Instead there was notification that a substitute piece of legislation would be introduced which would make the plan more attractive to the groups who are against this major change. We wait to see what the substitute legislation will look like, but signals from the chair of the committee along with the Speaker of the House is that the new legislation will have the 48 month limit included in it.

The House Judiciary committee came together with the House Health Policy committee to take testimony on House Bills 4694, 4695, 4696 and 4697, which is enabling legislation to create Mental Health courts statewide in Michigan, bring them under the authority of the State Court Administrator's Office (SCAO) and allow them to direct funding for the program. The General Government Omnibus budget included $2 Million for the courts in Michigan, now with this legislation it these court could become a reality. The joint committee heard testimony from those involved in the Mental Health court in Kalamazoo on Tuesday when the joint committee meet. The Judiciary committee continued taking testimony on this issue on Thursday hearing from the judge in charge of the Mental Health court in Kalamazoo. This legislation is likely to be moved out of the committee at their next meeting as this was one of the issues that Republicans were interested in moving before the start of the break.

The House Health Policy Committee also meet this week to consider a host of issues including taking a vote on House Bill 4736, a bill that would bring EPT to Michigan. The legislation made it out of committee with no signs of fight back from the members of the committee with a vote of 13 yes votes 0 No votes and 2 passes. Now the legislation will be sent to the full House for their consideration and we are hopeful for a vote before the House members leave for break. The committee also took a vote on changing the grade requirement for immunizations. The push to to move the record from 6th to 7th grade since those who are in 6th grade may be younger than what traditionally someone in 6th grade would be. This legislation headed to the House as well.

The Coming Weeks:

The House has several large issues they are looking to tackle before heading home on their summer recess. Transportation and road funding is the major problem facing the legislators at the moment. Looking to increase the tax on gasoline while it is so high or tacking on an increase to your registration fees are just a couple of the ways the House is looking at to solve this road funding issue. Medicaid expansion will be in the limelight for the next couple weeks as well. The House is committed to get their Medicaid reform legislation to the Senate before break. Those are the two largest issues facing the legislature that are trying to be teed up to send to the other chamber.

For more information on what is happening in Lansing and beyond follow us at http://www.msms.org/advocacy. You can get all of the information there and from our Facebook and Twitter feeds. What to know what is happening politically? Check out MDPAC at http://www.mdpac.org to get all the information on who will be running for what in the coming months ahead.

Sunday, June 2, 2013

This week the legislature saw a short but very important week with the House working hard to meet it's self imposed deadline of getting the budget approved. Let's take a look at what happened before the legislators left for the week:

Budget:

The Detroit Regional Chamber had it's annual policy conference on Mackinac Island this week that included names like Governors Jeb Bush and Scott Walker. This left the legislator looking at a shorten schedule for this past week with the conference starting on Wednesday. The House started with the School Aide budget with an increase in the foundation allowance for most school districts around Michigan that averaged out to $52 per student. The Senate agreed with the House and the Conference Committee' s work and passed the Education Omnibus budget, sending it to the Governor for his signature.

The General Government Omnibus budget is still in limbo. The House received the report of the Conference Committee, a report that came without the Medicaid Expansion. Mental Health Services saw the majority of extra funding with the Governor's push for greater access and increased services for those needing mental services. The House voted the bill out on party lines to the Senate for their approval but the Senate decided with the short timeline for the week that they were not interested in rushing the budget through. The Senate will be considering the budget this coming week.

This coming week the budget will be finalized, Expedited Partner Therapy could see a vote in the House Health Policy committee along with other action. Stay will MSMS to get the most up to date information at http://www.msms.org/advocacy.